Individual
MARY ELLEN THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP-BC
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-2286
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-2286
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
RN214814
GA
Other
Enumeration date
08/21/2015
Last updated
06/21/2019
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